Can you recover from hypothalamic amenorrhea if you’re vegan?

Veganism and hypothalamic amenorrhea (HA)… While they may not appear obviously linked, being vegan can actually impact your recovery from Hypothalamic Amenorrhea and disordered eating behaviours. In both subtle and overt ways, veganism can both propagate food rules and fears, and also make it more difficult to meet your increased energy requirements during recovery.

We spoke to Accredited Nutritionist @naturally_nina_ about her own journey to recovery from a long battle with eating disorders as a vegan, and how this dietary choice to be vegan can impact the journey to full recovery.

Nina initially decided to adopt a vegan diet for ethical reasons. However, like many others in eating disorder recovery, restricting her diet and eliminating all animal products began a slippery slide into introducing new, depriving food rules into her life.

Lifestyle choice, or diet-in-disguise?

“For the first few years of being vegan, I had all these false ideas of what ‘healthy eating’ was. I placed a huge number of rules on my diet without even realising it at first – because I ‘was doing it for my health’… I had to eat oil-free, salt-free, sugar-free, gluten-free, very low-fat, whole foods only and no processed foods,” Nina explains. 

She says, thanks to her history of disordered eating, it was all too easy to continue to restrict foods from her diet, which took a serious toll on her mental health.

This is a common experience of women in recovery who decide to follow a vegan diet. What initially appears to be a well-intentioned lifestyle choice, quickly turns into a diet-in-disguise, or an excusable way to continue carefully controlling whatever food you allow yourself to eat. Basically, for some people, it’s a way to continue their disordered eating habits and behaviours under the guise of an “ethical” or “health-aligned” choice.

Nina found her anxiety around eating food prepared by others or at a restaurant, or any meal containing unknown ingredients and calories, quickly returned. She was only comfortable eating homemade food she’d painstakingly prepared herself.

“It was impossible for me to eat enough this way to meet my nutritional and energy requirements, and I lost weight, became frail and weak again. My hair fell out in chunks, and I definitely wasn’t even close to having a period,” Nina explains.

Meeting your energy requirements as a vegan

This is another concern for those following a vegan diet during recovery: this dietary pattern makes it more challenging to meet your increased energy needs in recovery.

Nina explains why this is the case. “Plant-based foods are inherently much more filling, higher in volume, higher in fibre and lower in energy… These foods, such as vegetables, legumes, fruit and whole grains, can also lead to digestive discomfort, such as constipation, gas, bloating and prolonged fullness, making it virtually impossible to meet your energy requirements in recovery,” Nina says. 

“This means it can be both physically and mentally very challenging to eat enough during HA recovery – however, not impossible!” she says.

 If you are finding yourself introducing other dietary rules, such as only allowing yourself to eat whole foods, or eating low-fat or low-sugar, it becomes even more difficult to meet this energy intake. As you know, during HA recovery you’re working to replenish the months and months of malnourishment your body has suffered, so you can restore your body’s function and energy levels to their optimal performance. And in doing so, you need to be consuming a very significant amount of energy.

So is it possible to stay on track in recovery and remain vegan?

Nina maintains the answer to this question is a resounding YES!

“It is really important to focus on including the right plant foods to support recovery – that means emphasising energy-dense, lower volume and lower fibre foods wherever possible, including more processed foods and really exploring and challenging any of those food rules that co-exist with the choice of being vegan,” Nina urges. 

She says regularly incorporating breads, wraps, baked goods, rice, pasta, oils, sauces, dressings, vegan meats/cheeses and dairy alternatives, granola and cereal, lots of nut butters, nuts and seeds, bars and smoothies are excellent options to help you meet those energy requirements.

She also suggests limiting your intake of beans, lentils, vegetables, leafy greens, fruits and high-fibre whole grains, to prevent the feelings of digestive discomfort and fullness she mentioned.

“Yes, some of these foods are more processed (than others), but if they are helping you meet your goal of recovering from HA, they are actually the ‘healthier’ choice than sticking with whole foods that leave you without a regular period,” Nina says.

On her own journey, she’s now managed to restore a very positive relationship with food and overcome her food rules and fears, and has made a complete recovery from HA – all while maintaining a vegan diet!

“I am now the healthiest I have ever been, both mentally and physically. My relationship with food is one I am truly happy and at peace with. Fancy that: Eating ‘less healthy’ actually made me so much healthier!” she explains.

So what advice do we have for any vegans in recovery?

“If you too are vegan, or are thinking of going vegan, I encourage you to really honestly reflect on the reasons ‘why’ you’re making this choice. Is it something you truly value and are passionate about for ethical and environmental reasons? Or is it just another way to create rules and restrictions around your diet and avoid a whole lot of foods?” Nina questions.

She says if veganism aligns with your values, and you’re willing to plan adequately to ensure you’re meeting your energy requirements in recovery, then recovery is possible if you’re prepared to do the work.

However, if veganism creates anxiety and stress around food, and encourages you to adopt other food rules, restrictions and fears, maybe it’s time to put a vegan diet aside for now and prioritise your recovery. 

“You can come back to it later if and when it feels like the right time,” she reminds us.

“These are all important things to consider, because at the end of the day, your health (mental and physical) has to come first! And for the record, you are NOT a bad person, selfish or a failure if you do decide to move away from veganism,” Nina elaborates. “Give yourself the compassion you deserve, just like you would offer to a friend if they came to talk to you about the exact same dilemmas they were facing.”

Nutrient requirements for vegans in recovery

If you do decide to continue with a vegan diet in recovery, there are some nutritional considerations to keep in mind.

Nina says it’s particularly important for vegans to supplement with B12 and possibly Vitamin D, and ensure adequate calcium intake, to compensate for a lack of availability of these nutrients in a plant-based diet.

Be sure to prioritise adequate calcium intake, to protect your bone health (which is already compromised during HA). Including food sources such as calcium-fortified plant-based milks, tofu, tahini, greens and beans is a good start, and some people may require supplementation in addition.

“It’s also really important to get in a good balance of macronutrients, which means ensuring a source of carbohydrates, plant protein and fats (not just vegetables!!) at most meals, to help you meet your requirements for both recovery and overall health and wellbeing,” Nina says.

So while Nina doesn’t believe being vegan worsens your risk of developing an eating disorder, and does still allow recovery (particularly given the rising availability of delicious vegan options out there!), she does insist on the importance of checking yourself and your food habits, to ensure you’re not simply looking to continue controlling your diet.

“If you are wanting to recover from HA and get your period back on a vegan diet, it is so possible! But it does require you making some changes to the way you eat, and your beliefs around what food choices are best for you,” Nina reminds us. She says reducing your fibre and whole food intake, and including more energy-dense and processed foods is a good place to start. “We know for a fact that eating the same way that left you without a period is not going to get it back!”

So take some time out to reflect on your reasons for adopting or maintaining a vegan diet during recovery. If you do decide to continue a vegan lifestyle during this time, consider these questions: 

• How can you increase your energy intake within a vegan diet to ensure you’re meeting your recovery needs? 
• Are you imposing other food rules and restrictions in addition to eliminating animal products? 
• Do you need to be more organised and planned to ensure you’re including energy-dense foods into your diet each day?

If you’d like to learn more about Nina’s experience of recovery, and how to ensure your plant-based diet meets your nutritional and energy requirements, you can find her on Instagram @naturally_nina_ or her website www.naturally-nina.com. She also has a bunch of plant-based recipes for you to try!